A few weeks ago, my partners and I were consulted to see a patient who had been injected outside of our city with the tainted steroids and was now admitted to the hospital.

As infectious disease doctors, we routinely care for patients with meningitis, but never have we treated a case of Aspergillus or Exserophilum meningitis, the type of fungal infection that has caused 23 deaths and sickened nearly 300 people with the largest number in Tennessee.

Vigilance on the part of an astute physician identified the first case of fungal meningitis, and then well-trained epidemiologists at the Tennessee Depart

ment of Health discovered additional cases, identified the causative agent and alerted the Centers for Disease Control and Prevention. This outbreak of meningitis is an opportunity for us to recognize the importance of our public health infrastructure and explore ways to further improve it.

When an infectious outbreak occurs in a health care facility, state and federal health officials — like crime detectives — search for a possible culprit: a product, a procedure, or a person. In this case, the contaminated product, methyprednisalone, a steroid injection, was the cause. The contamination occurred at the compounding pharmacy that distributed the medicines.

In other outbreaks, the culprit has been poor technique in a procedure or a lack of proper hand hygiene. For example, in Nevada, an endoscopy clinic reusing syringes led to the transmission of hepatitis C to eight patients and placed 50,000 patients at risk. And in Georgia, five patients developed joint infections from MRSA, an antibiotic-resistant staph bacterium, in part due to poor hand-washing among health care staff at a primary care clinic.

Such infections are a stark reminder of the cat-and-mouse game that humans and pathogens play in our complex health care settings. So how can we get the upper hand?

First and foremost, we need to bolster our surveillance of both rare and common diseases. For example, we need to hardwire our communication among providers and health departments through laboratory systems and electronic medical records.

Second, regulations and guidelines related to potential infections need to be enforced. Last year, the CDC developed a detailed checklist for both administrators and front-line personnel to prevent infections in outpatient settings, yet no one knows if the recommendations are being followed. In our city, we need to be certain that outpatient clinics such as surgery centers follow these guidelines.

Third, transparency and public reporting of infections from hospitals and outpatient settings is necessary to reduce infection rates. For example, in 2008, after Tennessee's Legislature mandated that hospital infections due to central lines (catheters that go into patients' veins) be publicly reported, we experienced a nearly 40 percent drop in central line infection rates in intensive care units. Our state legislatures need to demand public reporting of other infections in health care settings.

Lastly, good public health requires taxpayer funding. I have worked with the Tennessee Department of Health, which has received additional funding over the past two years, and I believe it has undoubtedly strengthened Tennessee's infection control infrastructure and allowed for a rapid and meticulous response to this fungal meningitis outbreak. Unfortunately, such support for county and state health departments is rare.

As an infectious disease doctor and an epidemiologist, I am confident that the fungal meningitis outbreak will be contained and eliminated — yet unquestionably, other infections and potential outbreaks are lurking.

We must use this opportunity to recognize the success of our public health infrastructure, which saves countless lives every day. Ironically, we recognize this only when an outbreak occurs.

Manoj Jain is an infectious disease doctor in Memphis who also writes for The Washington Post. Archived articles are available at MJainMD.com.